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Death rates and causes in anticoagulated atrial fibrillation patients: a population-based study

Gentian Denas1, Ugo Fedeli2, Nicola Gennaro2

  • 1Cardiology Clinic, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova.

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|May 2, 2020
PubMed

Insights

Patients on direct oral anticoagulants (DOACs) have lower mortality than those on vitamin K antagonists (VKAs). DOACs also showed similar intracranial hemorrhage mortality to the general population.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Public Health

Background:

  • Atrial fibrillation (AF) patients require anticoagulation to prevent stroke.
  • Comparing mortality risks between direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) is crucial for patient care.
  • Understanding the impact of anticoagulation on overall and cause-specific mortality in AF patients compared to the general population is essential.

Purpose of the Study:

  • To compare all-cause mortality between anticoagulated atrial fibrillation (AF) patients and the general population.
  • To compare mortality rates among different anticoagulation therapies, specifically direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs).
  • To assess the risk of intracranial hemorrhage (ICH) mortality in AF patients on DOACs and VKAs compared to the general population.

Main Methods:

  • Population-based study utilizing administrative claims data from the Veneto Region (July 2013-September 2017).
  • Inclusion of all residents aged 18 years and older.
  • Propensity score matching to compare anticoagulation-naïve AF patients initiated on DOACs versus VKAs.

Main Results:

  • A total of 17,225 patients on DOACs were matched 1:1 with VKA patients (median age 77 years, 49% males).
  • Mortality was 22% higher in the DOAC group and 39% higher in the VKA group compared to the general population.
  • Intracranial hemorrhage (ICH) mortality was similar to the general population with DOACs (SMR 1.06) but nearly doubled with VKAs (SMR 1.92).
  • DOACs demonstrated a 44% reduction in ICH mortality risk compared to VKAs (HR 0.56).

Conclusions:

  • Anticoagulated atrial fibrillation patients exhibit increased mortality compared to the general population, with VKA users facing higher risks.
  • Direct oral anticoagulants (DOACs) are associated with a lower risk of death from intracranial hemorrhage compared to vitamin K antagonists (VKAs).
  • The mortality rate for intracranial bleeding in patients on DOACs is comparable to that of the general population.
Abstract

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